Is proton beam therapy always better than photon irradiation? Lessons from two cases

Li, MP; Yeo, A; Gunewardena, R; Drum, G; Wiltshire, K; Phillips, C; Sia, J; Wheeler, G; Hall, L

Author(s): Li, MP; Yeo, A; Gunewardena, R; Drum, G; Wiltshire, K; Phillips, C; Sia, J; Wheeler, G; Hall, L;
Details: Publication Year 2024,Volume 71 Suppl 2,Issue #Suppl 2,Page 90-98
Journal Title: Journal of Medical Radiation Sciences
Publication Type: Case report
Abstract: Proton beam therapy (PBT) is increasingly used to treat cancers, especially in the paediatric and adolescent and young adult (AYA) population. As PBT becomes more accessible, determining when PBT should be used instead of photon irradiation can be difficult. There is a need to balance patient, tumour and treatment factors when making this decision. Comparing the dosimetry between these two modalities plays an important role in this process. PBT can reduce low to intermediate doses to organs at risk (OAR), but photon irradiation has its dosimetric advantages. We present two cases with brain tumours, one paediatric and one AYA, in which treatment plan comparison between photons and protons showed dosimetric advantages of photon irradiation. The first case was an 18-month-old child diagnosed with posterior fossa ependymoma requiring adjuvant radiotherapy. Photon irradiation using volumetric modulated arc therapy (VMAT) had lower doses to the hippocampi but higher doses to the pituitary gland. The second case was a 21-year-old with an optic pathway glioma. There was better sparing of the critical optic structures and pituitary gland using fractionated stereotactic radiation therapy over PBT. The dosimetric advantages of photon irradiation over PBT have been demonstrated in these cases. This highlights the role of proton-to-photon comparative treatment planning to better understand which patients might benefit from photon irradiation versus PBT.
Publisher: Wiley
Keywords: Adolescent; Humans; Child; Infant; Young Adult; Adult; *Proton Therapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; *Radiotherapy, Intensity-Modulated; *Radiosurgery
Department(s): Radiation Oncology
Publisher's Version: https://doi.org/10.1002/jmrs.773
Open Access at Publisher's Site: https://doi.org/10.1002/jmrs.773
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-07-11 07:07:10

Last Modified: 2024-07-11 07:07:39